Method and system for centralized patient monitoring management

ABSTRACT

A method of centralized monitoring management at a centralized monitoring unit (CMU) includes receiving patient monitoring data from multiple patient monitoring devices, each providing patient monitoring data for one of multiple patients, and assigning each of the multiple patients to one of at least two monitoring technician stations. Each monitoring technician station is configured to receive and display patient monitoring data the patients assigned thereto and to present alarms for each patient to a CMU technician. A load index is calculated for each monitoring technician station based on the alarms for each patient in the group of patients assigned to that monitoring technician station. At least one patient is removed from the group of patients assigned to a first monitoring technician station of the at least two monitoring technician stations based on the load index for the first monitoring technician station. The patient removed from the first monitoring technician station is then reassigned to a different one of the at least two monitoring technician stations so as to distribute an overall alarm load for the CMU across all of the at least two monitoring technician stations.

BACKGROUND

The present disclosure generally relates to patient monitoring, and morespecifically to methods and systems for centralized patient monitoringmanagement at a centralized monitoring unit (CMU) receiving patientmonitoring data from patient monitoring devices for multiple differentpatients throughout a medical facility or throughout multiple medicalfacilities.

SUMMARY

In one embodiment, a method of centralized monitoring management at acentralized monitoring unit (CMU) includes receiving patient monitoringdata from multiple patient monitoring devices, each providing patientmonitoring data for one of multiple patients, and assigning each of themultiple patients to one of at least two monitoring technician stations.Each monitoring technician station is configured to receive and displaypatient monitoring data the patients assigned thereto and to presentalarms for each patient to a CMU technician. A load index is calculatedfor each monitoring technician station based on the alarms for eachpatient in the group of patients assigned to that monitoring technicianstation. At least one patient is removed from the group of patientsassigned to a first monitoring technician station of the at least twomonitoring technician stations based on the load index for the firstmonitoring technician station. The patient removed from the firstmonitoring technician station is then reassigned to a different one ofthe at least two monitoring technician stations so as to distribute anoverall alarm load for the CMU across all of the at least two monitoringtechnician stations.

A CMU receiving patient monitoring data from multiple patient monitoringdevices includes at least two monitoring technician stations and anassignment management module. Each monitoring technician station isconfigured to receive and display patient monitoring data for eachpatient in a group of patients assigned thereto and to present alarmsfor each patient in a group of patients to the CMU technician. Theassignment management module is executable by a processing system tocalculate a load index for each monitoring technician station. At leastone patient of the multiple of patients assigned to a first monitoringtechnician station is removed based on the load index for the firstmonitoring technician station. The at least one patient removed from thefirst monitoring technician station is then reassigned to a differentone of the at least two monitoring technician stations.

Various other features, objects, and advantages of the invention will bemade apparent from the following description taken together with thedrawings.

BRIEF DESCRIPTION OF THE DRAWINGS

The drawings illustrate the best mode presently contemplated of carryingout the disclosure. In the drawings:

FIG. 1 schematically depicts an exemplary embodiment of a centralizedmonitoring unit receiving patient monitoring data from patientmonitoring devices in multiple medical facilities.

FIG. 2 is a block diagram representing a central computing system havingan assignment management module executable to perform load managementfunctions as described herein.

FIG. 3A illustrates an exemplary list of alarm activity over a period oftime for an exemplary group of patients assigned to a CMU technician.

FIG. 3B illustrates exemplary schedules for calculation of burden valuesassociated with alarm types and care activity types.

FIGS. 4-10 depict various embodiments of methods, or portions thereof,of centralized patient monitoring management at a CMU.

DETAILED DESCRIPTION

Medical device alarms are helpful to draw clinician attention to alarms,which may regard technical issues with the patient monitoringarrangement or devices or a physiological event detected in thephysiological data recorded from that patient. However, given the numberof patient monitoring devices and other care devices that generatealarms, often simultaneously, alarm response can overburden andoverwhelm clinicians and present a barrier to effectively managing andresponding to alarms, some of which are for critical health-relatedemergencies. If too many alarms are initiated, clinicians are likely tosuffer from alarm fatigue and, if auditory alarms are generated,patients hearing the alarms are likely to become agitated.

Accordingly, there is a need for an effective monitoring managementsystem capable of receiving and processing patient monitoring data andalarm information and to determine which alarms are in need of responseby a clinician. In one embodiment, a centralized monitoring unit (CMU)receives patient monitoring data from multiple patient monitoringdevices connected to multiple different patients and facilitatesassessment of alarms for each patient by a CMU technician. The CMUtechnician assesses the alarm, such as to determine whether the alarmwarrants a visit from a clinician to the patient and then facilitatesnotification of the alarms to a responding clinician. The inventor hasrecognized that in such a CMU, technicians may also become overburdened,especially where the CMU technician may be assigned to a group ofpatients that is generating an especially high number of alarms orespecially burdensome or critical alarms. Accordingly, the inventor hasrecognized that systems and functions are needed for workload managementamongst CMU technicians working at monitoring technician stations in aCMU, including workload estimation, resource assessment, and loadbalancing.

FIG. 1 depicts one exemplary embodiment of a centralized monitoring unit(CMU) 30 in communication with and receiving patient monitoring data,including alarm-related data, from multiple patient monitoring devices16. In the depicted embodiment in FIG. 1, the CMU 30 receives patientmonitoring data from multiple patient monitoring devices 16 monitoringmultiple different patients 3 at two medical facilities 18 a and 18 b.In certain embodiments, the CMU 30 may be associated with and receivingpatient monitoring data from patient monitoring devices 16 a-16 c withinone medical facility 18, such as a hospital 18 a. In such an embodiment,the CMU 30 may be located within the medical facility 18 or may belocated remotely. In other embodiments, the CMU 30 may receive patientmonitoring data from patient monitoring devices 16 at multiple medicalfacilities, such as from multiple hospitals, outpatient facilities,medical clinics, etc. within a hospital or provider network. Within amedical facility 18 a, 18 b, the patient monitoring devices 16 may belocated in a plurality of medical care units. Each medical care unit maybe specific to a particular type of care. Non-limiting examples ofmedical care units include, but are not limited to, medical telemetryunits, step down units, emergency rooms, intensive care units, specialtyintensive care units (e.g., cardiovascular ICU), neonatal and/orpediatric care units, post-operative care units, etc.

The CMU 30 includes two or more monitoring technician stations (MTSs) 32(e.g., 32 a-32 c). The CMU 30 may receive patient monitoring data fromany number of two or more patient monitoring devices 16 a-16 ccollecting and monitoring physiological data from patients 3 a-3 c. Eachpatient 3 a-3 c is assigned via the CMU 30 to one of the MTS 32 a-32 csuch that each MTS 32 a-32 c has an assigned group of patients for whichit facilitates monitoring by a respective CMU technician 36 a-36 c. Inanother embodiment, a monitoring technician 36 may manually admit apatient to their station, such as seeing that a new patient needsassignment and manually accepting assignment to their respective MTS 32a-32 c. The patient monitoring device 16 a-16 c may be any devicecollecting and/or assessing physiological data from the patient 3 a-3 c.Examples include an electrocardiograph (ECG), non-invasive bloodpressure monitor (NIBP), invasive blood pressure monitor, Sp02 monitor,electroencephalograph (EEG), respiration monitor, or any othermonitoring device capable of collecting physiological or other patientmonitoring data. As is common, multiple patient monitoring devices maybe connected to each patient 3 a-3 c. The patient monitoring data fromeach patient monitoring device 16 a-16 c is transmitted to the CMU 30,such as via the computer network of the medical facility 18 a and/or theinternet.

A CMU technician 36 operates each MTS 32 in order to review patientmonitoring data and assess alarms from multiple different patients(e.g., 3 a-3 c). The CMU technician 36 assess the patient monitoringdata from patient monitoring devices 16 for each patient 3 in a group ofpatients admitted or assigned to the CMU technician's MTS 32. Withreference to the example in FIG. 1, the first MTS 32 a may be configuredto receive and display patient monitoring data for each patient 3 a-3 cin a group of patients 5 assigned thereto, and present alarms for eachpatient 3 a-3 c in the group of patients 5 to the CMU technician 36 a.The CMU technician 36 a then assesses the patient monitoring dataassociated with each alarm. In certain embodiments, an alarmnotification may also be sent automatically to the caregiver or careteam via a secondary alarm notification system; however, in most cases,the technician 36 a will still need to conduct some level of assessment.For example, the CMU technician 36 a assesses the patient monitoringdata to determine whether the alarm is one that needs to be responded toby a responding clinician or technician, or whether the alarm is a falsealarm (e.g., caused by a noisy signal) or otherwise does not require avisit to the patient's location by a clinician (to physically assessand/or treat the patient) or technician (to assess the patientmonitoring device and/or sensors attached to the patient).

The CMU 30 includes a central computing system 40 comprising anassignment management module 42, which is a software module comprisingcomputer executable instructions for managing workload assignments tothe two or more monitoring technician stations 32 a-32 c. Eachmonitoring technician station (MTS) 32 a-32 c comprises one or moredisplay(s) 33 that visually present patient monitoring data for variouspatients to a CMU technician 36 a-36 c. Each MTS 32 a-32 c furtherincludes one or more user input devices 34 through which the CMUtechnician can input information and/or navigate the central monitoringuser interface provided on the graphical display(s) 33. Each CMUtechnician 36 a-36 c assesses the patient monitoring data relevant toeach alarm and documents, where appropriate, the assessment via the userinput devices at the MTS 32, such as a mouse, keyboard, touchpad,touchscreen, voice recognition system, or any other standard ornon-standard user input device or system. Alternatively, thedocumentation could be conducted on paper.

In one embodiment, each MTS 32 a-32 c includes its own computing systemthat is communicatively connected to the central computing system 40 andruns the displays 33 and receives input from the user input devices 34in order to facilitate the functions of the CMU technician 36 a-36 coperating the respective MTS 32 a-32 c. Alternatively, each MTS 32 a-32c may operate on the central computing system 40, which may beconfigured to run multiple instances of the centralized monitoring userinterface—e.g., a cloud computing environment.

Each MTS 32 is configured to facilitate assignment of alarm response orother patient treatment or assessment to at least one respondingclinician 8, which may be a care team comprised of more than oneclinician. For example, the CMU technician 36 may operate thecentralized monitoring user interface provided at the MTS 32 to link aresponding clinician 8 to an alarm for a patient. The centralizedmonitoring user interface may facilitate communication between the CMUtechnician 36 and the responding clinician 8, such as by allowing textand/or voice communication between each MTS and a clinician device 48,such as a smart phone or other personal computing device. For example,the clinician device 48 may be a personal computing device running anapplication to provide the centralized monitoring user interface(s) thatfacilitates communication of alarm assignments to that clinician 8and/or communication between the clinician 8 and the CMU technician 36regarding the assignment, the patient condition, and/or whether theclinician 8 is able to respond to the alarm assignment. For example, theclinician 8 may utilize the clinician device 48 to accept or deny thealarm dispatched, and the acceptance or denial may be communicated tothe CMU technician at the corresponding MTS 32 a-32 c. If the clinician8 denies the dispatched alarm, then the CMU technician 36 may assign thealarm to a different responding clinician or be automatically escalatedto another assigned clinician such as via an integrated secondary alarmnotification solution. Once made, each responding clinician assignmentmay stay with each patient, regardless of any transfer of patients orpatient groupings among MTSs 32 a-32 c. Thus, the notifications foralarm responses for a particular patient may move with the patientautomatically when the patient gets reassigned to a different MTS 32a-32 c such that the notifications continue to be routed to the sameresponding clinician or group of clinicians.

Each of the patient monitoring devices 16 are exemplarilycommunicatively connected by a local network which may be operated by alocal server 20 which may exemplarily handle and process the data fromeach of the patient monitoring devices 16 in an area, such as in ahospital or care unit. In an exemplary embodiment, wherein the CMU 30 isimplemented at a single hospital or other location, the local server 20may be in direct communication with the central computing systems 40. Ina more distributed or cloud-based implementation, a communicationsgateway 22 may communicatively connect the local server 20 to thecentral computing system 40 of the CMU 30. As also illustrated in FIG.2, the central computing system 40 exemplarily receives alarm data 52and patient monitoring data 50 for each of the patient monitoringdevices 16 exemplarily through at least one of the local server 20 andthe communications gateway 22 and makes the data accessible to theassigned CMU technician 36 a-36 c via the corresponding MTS 32 a-32 c.

Each patient 3 a-3 c for which patient monitoring data is being receivedis assigned to one of the MTSs 32 a-32 c for review by the respected CMUtechnician 36 a-36 c manning that MTS. Thus, each MTS 32 a-32 c has agroup of two or more patients 3 a-3 c assigned thereto. In FIG. 1, arepresentative group 5 of patients 3 a-3 c is assigned to a first one ofthe MTSs 32 a, other groups of patients (not shown) are assigned to eachof the other two MTSs 32 b-32 c. The multiple patients 3 being monitoredmay be divided and assigned amongst the groups 5 assigned to the variousMTS 32 a-32 c by various methods described herein. As also describedhereinbelow, the assignment of patients to the MTSs 32 a-32 c iscontinually managed so that the workload for all of the patients beingmonitored at the CMU 30 is distributed across all of the MTS 32 a-32 cin an effective and equitable manner so that no single CMU technician 36a-36 c is overburdened compared to other technicians and so that allalarms can be assessed in the most prompt and efficient manner possible.

The assignment management module 42 operates as described herein tocalculate a load index for each MTS 32 a-32 c and redistribute patientassignments to the various MTS 32 a-32 c based on the load indexes andthe active alarms so as to efficiently and effectively distribute anoverall alarm load for the CMU 30 across all of the MTSs 32 a-32 coperated by a CMU technician 36 a-36 c. Thus, while a patient may beinitially assigned to a particular monitoring technician station 32 a-32c upon intake, that assignment may change over time based on the overallalarm load and/or based on loading at any particular MTS 32 a-32 c. Inone example, a patient may be initially assigned to a monitoringtechnician station 32 a-32 c that has the lowest load index at the timeof assignment, such as upon intake of the patient or upon receipt ofinitial monitoring data for that new patient. Alternatively, the initialassignment or admission may be based on the expertise of the monitoringtechnician 36 a-36 c manning each respective MTS 32 a-32 c. The initialassignment of a new patient to an MTS 32 a-32 c may be performedautomatically by the assignment management module 42, such as based onthe current load indexes based on the current assignments, or suggestthe MTP to which to assign the patient for confirmation by a systemmanager or administrator overseeing assignment prior to executing theassignment. The continual monitoring for that patient over time may thenbe transferred to various MTSs 32 a-32 c based on a load index for eachMTS 32 a-32 c, a forecasted load index for each MTS 32 a-32 c, anoverall alarm load for the CMU 30, particular skill levels and/orexpertise of CMU technicians 36 a-36 c (who may change shifts, etc.), orany other various factors disclosed herein.

In one embodiment, the CMU 30 houses an assignment management module 42comprising computer executable instructions housed in software 202 andexecutable by one or more processors 44 comprised in a processing system206. As shown in the system diagram of FIG. 2, the assignment managementmodule 42 is configured to receive patient monitoring data 50 andvarious other inputs and schedules and to calculate load indexes 72, onefor each MTS 32 of the CMU 30, and to make MTS assignments 70 ofpatients 3 to each MTS 32 in order to distribute an alarm load for theCMU 30. In the depicted example, the assignment management module 42receives active alarm notifications 52 for each patient 3 beingmonitored at one of the MTSs 32. The active alarm notification 52identifies one or more of the alarming device and type of alarm, and mayalso identify the physiological measurement values that triggered thealarm, especially for limit alarms (see FIG. 5B and associateddiscussion below). The active alarm notification 52 may also identify apatient 3 a with which the alarm is related. The assignment managementmodule 42 then calculates a load index 72 for each MTS 32 based on theactive alarms being handled there. In certain embodiments, the loadindex 72 for each MTS 32 may be calculated based further on technicianresponse inputs 54 by the CMU technician at the respective MTS 32. Thetechnician response inputs 54 may include acknowledgments of an activealarm and other inputs to the centralized monitoring user interface atthe respective MTS 32 for assessment of an active alarm, such as toreview patient monitoring data for the patient and/or patient health orother related information considered as part of the alarm assessment.For example, the technician response inputs 54 may include window orbutton selections, information input, etc. via the user input device(s)34 at the MTS 32. Such information may be tracked in order to determinewhat review and response actions have been taken by the CMU technician36.

The technician response inputs 54 may further include cliniciancommunication, such as communication with a responding clinician 8 orresponding technicians, and/or consultation with other clinicians,technicians, or subject matter experts. Such information may beconsidered when calculating the load index 72, such as to determine anactual response time 78—i.e., an actual amount of time that respondingto a particular alarm has consumed. In certain embodiments, the loadindex 72 may also be calculated based on the total duration ofcontinuous alarming experienced at the MTS 32, which is the total timethat alarms have been continuously handled by the CMU technician 36without time therebetween or with less than a predetermined amount oftime between alarms.

Additionally, the actual response time 78 can be compared to an expectedresponse duration, such as determined based on alarm type. For example,an expected response duration may be provided in one or more burdenvalue schedules 58. Burden value schedules 58 (exemplified at FIG. 3B)provide expected response information for each of various alarm typesthat could be generated by the patient monitoring devices 16 providingpatient monitoring data 50 to the CMU 30. For example, the burden valueschedule 58 may provide an expected response duration for each alarmtype listing an expected amount of time required to assess an activealarm, determine whether a clinician response is needed, and hand offthe matter to a responding clinician 8. The burden value schedule 58 mayfurther identify an expected complexity of an alarm type, such as torepresent how much attention and energy will be required by the CMUtechnician 36 to assess and/or assign an active alarm of the particularalarm type. Additionally, the burden value schedule 58 may specify anexpected documentation duration by alarm type, such as to specify aduration required to complete documentation of the technician'sassessment and assignment and/or document any other information relevantto an alarm. For example, the expected documentation duration mayrepresent the period of time required after assignment of an alarm to aresponding clinician 8 and/or determination that no clinician responseis necessary and silencing or termination an alarm condition.

The assignment management module 42 may consider the burden valueschedule 58 when calculating the load index 72 for each MTS 32, such asto determine a burden value for each active alarm being addressed at theMTS 32, which is based on the type of each respective alarm andindicates the estimated burden on the CMU technician 36 caused by eachrespective alarm. In certain embodiments, the assignment managementmodule 42 may be configured to further assess a load threshold schedule60 in determining the load index and/or determining a load threshold foreach individual MTS 32 to which the respective load index should becompared. For example, the load threshold schedule 60 may listinformation regarding the skill level of the CMU technician 36 at therespective MTS 32. The skill level information may be used in variousways. For example, the skill level information may be utilized to modifythe information in the burden value schedule 58. For example, amultiplier may be provided to information in the burden value schedule58 based on the technician skill level to account for the variedabilities of the technicians (e.g., 36 a-36 c) who may be responding toalarms. For example, an inexperienced technician may take longer toassess and respond to an alarm and the complexity of their response mayincrease, such as due to the need to consult with another technicianand/or a subject matter expert. Conversely, an experienced technicianmay be able to assess and respond to an alarm condition more quickly andefficiently. Thus, the burden value calculated for an inexperiencedtechnician may be higher than for an experienced technician for the samealarm type.

In one embodiment, a patient burden value may be calculated for eachpatient, and the assignment management module 42 may then calculate theload index 72 for each MTS 32 as the total of the patient burden valuesfor the patients assigned thereto. FIG. 10 is a flow chart illustratingone such example where load index 72 is calculated based onpatient-specific values. A patient burden value is calculated for eachpatient at step 180. The patient burden value may be calculated based onan alarm burden schedule as described herein. Referencing FIG. 3A as anexample, a burden value may be calculated for each patient (e.g.,patient 234, patient 345, etc.) based on the listed activity for thatpatient and using appropriate burden schedules. Then, based on the groupof patients for each MTS 32 identified at step 182, a load index iscalculated at step 184. The load index 72 for a respective MTS 32 isdetermined based on the patient burden values, such as the sum of thepatient burden values for the group of patients 5 assigned to aparticular MTS 32. The load index 72 is then compared to a threshold atstep 186 to identify whether there are any overloaded MTSs 32. Based onthe MTS load indexes, the assignment management manager may thendetermine and provide, through optimization algorithms, reassignmentrecommendations, balancing the load levels of the MTSs in the CMU.

The technician skill level may be utilized to calculate a load thresholdfor each technician to which the load index is compared. For example, aninexperienced CMU technician 36 may be assigned a lower load thresholdthan an experienced technician. In certain embodiments, the load index72 calculated for each MTS 32 may be compared to the load index assignedto the CMU technician 36 working at that MTS 32. If the load index 72exceeds the respective load threshold, then that MTS 32 may beidentified as an overloaded MTS indicating a need for reassignment ofone or more patients in order to adjust the alarm load distribution.

The load threshold schedule 60 may further include other load balancingfactors and/or equations, such as to account for various considerationswhen assigning burden value for each active alarm and/or load thresholdfor each CMU technician 36. Examples of additional load balancingfactors could include modifiers to account for factors such as clinicianfatigue (e.g., to lighten a load on a clinician after a period of highstress or high load). Alternatively or additionally, the load thresholdschedule 60 may include equations and/or other information on how tobalance an overall alarm load across all MTS 32 a-32 c of the CMU 30.Additional factors may be considered in addition to load index 72, suchas the differences between load indexes amongst the various MTS 32 a-32c. For example, the load threshold schedule 60 may include a thresholddifference between load indexes 72 that may also trigger a loadrebalancing.

Load rebalancing may further account for forecasted values indicatingfuture load, and thus rebalancing may occur prior to a load index 72exceeding a load threshold. For example, the assignment managementmodule 42 may calculate a forecasted load index 74 for each MTS 32. Theforecasted load index may account for any of several factors, includingan actual response time 78 and/or technician response inputs 54. Forexample, a technician may indicate that a response will exceed theexpected response duration and/or has an unusually high complexity basedon the particular alarm type. The load index 72 or forecasted load index74 may be modified upwards accordingly, alternatively or additionally,the forecasted load index 74 may account for alarm probabilities 76,which indicate the probability of an alarm being generated within apredetermined future time period based on the patient monitoring data 50or related patient information. For example, alarm probabilities 76 maybe increased for certain monitoring devices as the monitored valuesapproach an alarm limit. Alternatively or additionally, alarmprobabilities 76 may be increased for a particular patient or patientmonitoring device 16 based on the other active alarms for that patient 3and/or based on patient information such as diagnosis or medicalhistory. For example, a critical ECG alarm may be closely followed byalarms generated by other patient monitoring devices, such as bloodpressure and/or SpO2. Accordingly, high alarm probability values mayaccount for those subsequent alarms, which may be reflected in theforecasted load index 74 for a particular MTS 32. Similarly, certainalarms may be more likely in predefined conditions for patients withcertain diagnoses or medical histories. The alarm probability 76 mayaccount for such information, and thus may increase when thosepredefined conditions or patterns are detected.

In certain embodiments, the assignment management module 42 may alsoreceive or calculate an overall alarm load 80 representing the alarmload across all MTS 32 a-32 c. In one example, the overall alarm load 80is a total of all load indexes 72 for the current operating MTS 32 a-32c for the CMU 30. In another embodiment, the overall alarm load 80 maybe determined based on the load indexes 72, and in some embodiments alsothe forecasted load indexes 74. In certain embodiments, the assignmentmanagement module 42 may be configured to account for the overall alarmload 80 for the CMU 30, such as to ensure that the load is notinequitably distributed to otherwise carried more by certain CMUtechnicians 36 may in others.

In one embodiment, the load determination is made based on burden valueschedules indicating factors to be accounted for when assessing load.FIG. 3B depicts exemplary burden value schedules 58 providing anon-exhausted list of alarm types and other care activity types that aCMU technician 36 might engage in such that most or all of the demandson the CMU technician are accounted for in the load index 72calculation. Each alarm type and/or activity type is associated withvarious information that may be considered in determining the burdenvalue for each active alarm. In the depicted example, the burdenschedules list an expected response duration and an expecteddocumentation duration for each alarm type. In certain embodiments, theburden value schedules 58 may further contain an expected complexityvalue and/or allow calculation of an expected complexity based on thevalues indicated therein. In the depicted example, each alarm type andcare activity type is classified into one of three expected complexityvalues, being low, medium, and high. Higher complexity values can bereflected in a higher burden value associated with the alarm type.

In various embodiments, the burden value schedules 58 may be configuredand provided upon installation of a CMU 30 and maintained and updated aspart of system maintenance. Alternatively or additionally, the schedulesmay be configurable, such as by a system administrator for the CMU 30.Thus, the burden value schedules 58 may be adjusted to account forparticular realities in the healthcare environment in which the CMU 30is operated. In still other embodiments, the assignment managementmodule 42 may be configured to automatically adjust the burden valueschedules 58 based on actual occurrences and operation at the CMU 30.For example, the assignment management module 42 may employ machinelearning algorithms to update the burden schedules 58, such as to updatethe expected response durations and/or expected documentation durationvalues in the burden schedule based on actual response times 78 for thevarious alarm types and actual documentation durations. Likewise, thecomplexity values may be updated, such as based on the technicianresponse inputs 54 measured for certain alarm types compared to theexpected response inputs reflected in the burden value schedule 58. Incertain embodiments, machine learning may be employed to maintain aburden value schedule 58 for each CMU technician 36 a-36 c, such as toaccurately predict the response and documentation times for thattechnician, and thus more accurately predicts the amount of load thatthe respective technician 36 a-36 c can effectively handle.

FIG. 3A provides an exemplary list of alarm activity detail for a groupof patients 5 assigned to a particular MTS 32. In the example, the groupof patients 5 consists of four patients, identified as patient 234,patient 345, patient 456, and patient 567. In the example, a number ofalarms are generated for each patient. The alarm activity schedule listsvarious alarm notification information 52, including alarm type andalarm start time. Certain additional information is also providedsummarizing certain activity totals for each alarm event, including thetotal alarm time and the number of alarm escalations, which representthe number of persons, such as responding clinicians or technicians 8,who were called in or tasked to respond to the alarm. Such escalationinformation and total time information may be utilized, for example, bythe machine learning algorithm to modify the burden schedule 58, whichmay be on a per-alarm-type basis and/or on a per-technician basis.

FIG. 2 is a block diagram representing an exemplary central computingsystem 40 of a CMU 30 having an assignment management module 42executable to operate as described herein. The central computing system40 includes a processing system 206, storage system 204, software 202,and a communication interface 208. The processing system 206 loads andexecutes software 202 from the storage system 204, including theassignment management module 42, which is an application within thesoftware 202. The module 42 includes computer-readable instructionsthat, when executed by the computing system 40 (including the processingsystem 206), direct the processing system 206 to operate as described inherein in further detail, including to determine the load index 72 foreach MTS 32 and to manage the load distribution among the MTSs 32accordingly.

Although the central computing system 40 as depicted in FIG. 2 includesone software 202 encapsulating one assignment management module 42, itshould be understood that one or more software elements having one ormore modules may provide the same operation. Similarly, whiledescription, as provided herein, refers to a single processing system206 having a single processor 44, it is to be recognized thatimplementations the processing system 206 can be performed using one ormore processors, which may be communicatively connected, and suchimplementations are considered to be within the scope of thedescription.

The processing system 206 includes the processor 44, which may be amicroprocessor, a general purpose central processing unit, anapplication-specific processor, a microcontroller, or any other type oflogic-based device. The processing system 206 may also include circuitrythat retrieves and executes software 202 from storage system 204.Processing system 206 can be implemented within a single processingdevice but can also be distributed across multiple processing devices orsub-systems that cooperate in executing program instructions.

The storage system 204, which stores the database 43 housing variousschedules 58, 60 and information necessary to facilitate the assignmentmanagement and load balancing activities by the assignment managementmodule 42, can comprise any storage media, or group of storage media,readable by processing system 206 and capable of storing software 202.The storage system 204 can include volatile and non-volatile, removableand non-removable media implemented in any method or technology forstorage of information, such as computer-readable instructions, datastructures, program modules, or other data. Storage system 204 can beimplemented as a single storage device but may also be implementedacross multiple storage devices or sub-systems. For example, thesoftware 202 may be stored on a separate storage device than thedatabase 43 housing the schedules 58, 60. Likewise, database 43 can bestored, distributed, and/or implemented across one or more storage mediaor group of storage medias. Similarly, database 43 may encompassmultiple different sub-databases at different storage locations and/orcontaining different information which may be stored in differentformats. Storage system 204 can further include additional elements,such a controller capable of communicating with the processing system206.

Examples of storage media include random access memory, read-onlymemory, optical discs, flash memory, virtual memory, and non-virtualmemory, magnetic sets, magnetic tape, magnetic disc storage or othermagnetic storage devices, or any other medium which can be used to storethe desired information and that may be accessed by an instructionexecution system, as well as any combination or variation thereof, orany other type of storage medium. Likewise, the storage media may behoused locally with the processing system 206 or may be distributed inone or more servers, which may be at multiple locations and networked,such as in cloud computing applications and systems. In someimplementations, the storage media can be a non-transitory storagemedia. In some implementations, at least a portion of the storage mediamay be transitory.

The communication interface 208 interfaces between the elements withinthe central computing system 40 and external devices, such as thecommunications gateway 22 at various medical facilities 18 a, 18 b inorder to receive patient monitoring data 50 and/or active alarmnotification data 52. The communication interface 208 may also interfacewith the computing systems of the MTSs 32 a (which in certainembodiments described above, may each comprise its own computing systemor in other embodiments may all be facilitated in a cloud computingenvironment).

The central computing system 40 may be associated with a user interface,such as for receiving input from and communicating information to asystem administrator. For example, the central computing system 40 maybe associated with one or more displays 46, which may display variousdashboards and/or other display tools indicating various statistics andinformation about the current load indexes 72 of the MTSs 32 and theoverall alarm load 80 or load distribution status for the CMU 30. Eachuser interface for the central computing system 40 (as well as each userinterface for each MTS 32) may include a mouse, a keyboard, a voiceinput device, a touch input device for receiving a gesture from a user,a motion input device for detecting non-touch gestures and other motionsby a user, and other comparable input devices and associated processingelements capable of receiving input from a user, such as a clinician.Output devices such as video displays can display an interface furtherassociated with embodiments of the system and method as disclosedherein. Speakers, printers, haptic devices and other types of outputdevices may also be included in the user interface.

FIGS. 4-9 provide flowcharts exemplifying embodiments of methods 100, orportions thereof, of centralized patient monitoring management at a CMU30. FIG. 4 depicts one exemplary method at a high level, where a loadindex is calculated and an overall alarm load is redistributedaccordingly. At step 101, instructions are executed to access a list ofactive MTSs 32 and corresponding CMU technicians 36 assigned thereto.The group of patients assigned to each MTS is accessed at step 102, anda load index is calculated at step 103 for each MTS 32. Step 104 isexecuted to detect an overloaded MTS (e.g., 32 a), after which at leastone patient is removed from the overloaded MTS 32 a at step 105 andreassigned to a different MTS 32 b-32 c at step 106—i.e., changing theMTS assignment 70 for that patient. A person having ordinary skill inthe art will understand in view of the present disclosure that variousmethods may be employed for calculating the load index 72 and detectingan overloaded MTS. Likewise, a person having ordinary skill in the artwill understand in view of the present disclosure that variousalgorithms may be employed to determine which patient or patients shouldbe removed from the overloaded MTS, and where those patients should bereassigned. In certain embodiments, the reassignment may be executedautomatically by the central computing system 40 upon detecting anoverloaded MTS, in other embodiments the central computing system mayseek approval input from on or more CMU technicians 36 or anadministrator prior to executing the reassignment.

FIGS. 5A and 5B depict exemplary steps for identifying an overloaded MTSand a low-load MTS in order to adjust the distribution of patients amongthe MTS. In FIG. 5A, a load threshold is determined for each MTS 32 a-32c at step 110. For example, the load threshold for each MTS 32 a-32 cmay be determined and set based on skill level of the CMU technician 36a-36 c at the respective MTS 32 a-32 c and/or other informationcontained in the load threshold schedule 60. The load index 72calculated for each MTS 32 is compared to its corresponding loadthreshold at step 111. Overloaded MTS are identified at step 112 basedon that comparison. For example, an overloaded MTS may be any MTS 32 forwhich the load index 72 meets or exceeds the respective load thresholddetermined for that MTS 32. One or more low-load MTSs are identified atstep 113, such as the one or more MTSs with the largest differencebetween the load index and the load threshold for that MTS (where theload index is less than the load threshold). In certain embodiments, thelow-load MTS may be identified based on a percentage basis, rather thanan absolute value basis, to account for the variation in load thresholdsbetween the CMU technicians 36 a-36 c. Instructions are then executed atstep 114 to remove at least one patient from the overloaded MTS andassign that patient to the low-load MTS.

The exemplary method steps in FIG. 5B employ a different method ofassessing load index and identifying overloaded MTS. A burden value isdetermined at step 118 for each active alarm, such as based on the alarmtype of each active alarm and the burden value schedule 58. Step 119 isthen executed to modify the burden value by the skill level of thetechnician, such as by multiplying the burden value calculated based onthe burden value schedule 58 by a multiplier value determined based onthe technician skill level from the load threshold schedule 60. Incertain embodiments, the load index 72 may be assigned as the modifiedburden value for each alarm for all of the patients in the group ofpatients assigned to the MTS 32. Alternatively, the load index may becalculated to only account for the more serious and burdensome alarmsbeing addressed at the MTS 32. In the exemplary embodiment of FIG. 5B,the load index is determined based on a number of alarms above athreshold modified burden value. Either way, the load index determinedbased on the modified burden value already accounts for the variousskill levels of the technicians, and any other burden factors dictatedby the load threshold schedule 60 discussed above. Thus, the loadindexes for the various MTSs 32 can be directly compared to one anotherin order to determine whether the load distribution needs to beadjusted. For example, the assignment management module 42 may beconfigured to determine a mean load index and compare the load indexes72 for each MTS 32 to the mean value in order to identify one or moreoverloaded MTS and one or more low-load MST, which is represented atstep 122. For example, a threshold deviation from the mean may be set toaccount for natural and tolerable deviations in load. The overloaded MTSand low-load MTS may be identified as MTS with load indexes that deviatefrom the mean by more than the threshold amount or threshold percentage.At the point, one or more patients are removed from the overloaded MTSand assigned to the low-load MST at step 123.

FIG. 6 is a flowchart representing exemplary steps for calculating loadthreshold to account for technician skill level. Instructions areexecuted at step 130 to identify the CMU technician 36 a-36 c assignedto a respective MTS 32 a-32 c. A skill level value is accessed for eachCMU technician at step 131, such as may be comprised in the loadthreshold schedule 60 discussed above. One or more threshold modifiervalues are determined at step 132 based on the skill level and the loadthreshold is calculated at step 133. For example, a default loadthreshold may be provided and may be multiplied by the thresholdmodifier value in order to account for the skill level. Other loadbalancing factors may be accounted for similarly, where a thresholdmodifier value may be determined at step 132 to account for multipleload balancing factors.

FIG. 7 is a flowchart depicting one embodiment of a load index 72calculation that accounts for the skill level and/or other loadthreshold values in the load index calculation, rather than in the loadthreshold calculation depicted in the example at FIG. 6. A burden valueis determined at step 138 and the burden value is multiplied by a skilllevel factor at step 139. The actual response time for each alarm isdetermined at step 140 and compared to the expected response duration inthe burden value schedule 58. If there is a difference between theactual response time for any one alarm and the expected responseduration in the burden value schedule, modified by the skill levelfactor, then an adjustment is made accordingly. The load index is thencalculated for each MTS at step 141 based on the adjusted burden value.Similar adjustments may be made to the expected complexity and expecteddocumentation duration values in the burden value schedule 58 in orderto arrive at the load index for each MTS.

FIG. 8A depicts one embodiment of a method for identifying which patientto remove from an overloaded MTS. A group of patients assigned to anoverloaded MTS is identified at step 146. From the group of patients,all unattended alarms for the MTS are identified at step 147, which areactive alarms not yet responded to by the CMU technician 36. This findsthe active alarms for which the clinician has not yet commencedassessment, such as due to being overloaded and busy responding to otheralarms. Of the unattended alarms at the MTS, the most criticalunattended alarm at the MTS is identified at step 148. Step 149 isexecuted to determine whether the identified critical alarm is for thesame patient as another active alarm being responded to at the MTS. Ifso, then the patient will remain at the MTS to be viewed by the sameclinician. This configuration may permit efficiency and consistency inresponse, rather than having multiple CMU technicians 36 responding todifferent alarms for the same patient 3. Thus, a different alarmingpatient must be identified and removed from the group of patientsassigned to the overloaded MTS. In that instance, step 150 is executedto identify the next most critical unattended alarm at the MTS. The nextmost critical alarm is again assessed at step 149 to determine whetherit is generated by the same patient as an alarm being responded to atthe MTS. If not, then the patient associated with the identified alarmat step 149 is removed from the overloaded MTS at step 151 andreassigned to a different MTS at step 152. In other embodiments, themethod may identify the oldest pending alarm not yet responded to at theMTS instead of the most critical alarm not yet responded to, and maygenerally follow the same assessment steps to identify an alarm that canbe removed from the overloaded MTS without disrupting the CMU technicianor negatively impacting patient care.

FIG. 8B depicts another embodiment of a method for identifying whichpatient to remove from an identified overloaded MTS. The group ofpatients assigned to the overloaded MTS 32 is identified at step 160.Within that group of patients, one or more patients that are notcurrently alarming are identified at step 161. An alarm probability isthen calculated for each monitoring device associated with one of thenon-alarming patients at step 162. Of the non-alarming patients, thepatient with the highest alarm probability is identified at step 163.The highest alarm probability is then removed from the overloaded MTS atstep 164 and is reassigned to a different MTS at step 165. In certainembodiments, the reassignment may be executed automatically so as toprovide automated load management, in other embodiments the centralcomputing system may seek approval input from on or more CMU technicians36 or an administrator prior to executing the reassignment. For example,the assignment management module 42 may be configured to generate aprompt at each of the overloaded and reassigned MTSs 32 seeking approvalinput prior to executing the reassignment. In another embodiment, theassignment management module 42 may be configured to generate a promptto a system manager or administrator overseeing assignments, orotherwise seek input from such an individual, prior to executing thereassignment.

FIG. 9 depicts an exemplary embodiment of method steps for determining aforecasted load index for each MTS 32. Step 170 is executed to determinean expected response duration for each active alarm at a respective MTS.For example, the expected response duration for each active alarm may bethe value provided in the burden value schedule 58 based on the responsetype of each active alarm. The expected response duration for eachactive alarm may be adjusted at step 171 based on the actual responsetime for each active alarm, for example if an alarm response is not ontrack or has already gone over the expected response duration, then thealarm response can be expected to take longer than the expected responseduration, and thus the expected end time of the alarm can be adjustedaccordingly. The alarm probability is then determined at step 172 foreach patient monitoring device associated with each patient in the groupof patients assigned to the respective MTS. Various methods fordetermining alarm probability are described above, such as based on thepatient monitoring data being sent by a particular patient monitoringdevice and/or based on one or more active alarms being generated for aparticular patient. A forecasted load index is then calculated for eachMTS at step 173 based on the alarm probabilities and the modifiedexpected response durations. The forecasted load index is compared tothe load threshold for the respective MTS at step 174 to determinewhether load rebalancing is needed. For example, if the forecasted loadindex exceeds the load threshold then it can be expected that thecorresponding MTS is likely to become an overloaded MTS. This situationcan be addressed in advance of overloading the MTS by moving one or morepatients likely to generate an alarm away from the MTS nearing its loadthreshold to one or more different MTSs with lower load indexes orforecasted load indexes.

In certain embodiments, a number of MTSs needed may be calculated, andMTSs may be added or removed based on that need. For example, the numberof MTSs needed may be determined based on the load indexes 72 andcurrent patient load for the MTSs 32, such as whether the currentpatient load is manageable (considering completion of any needed orsuggested rebalancing and reassignments as described herein) such thatthe load indexes 72 can be maintained at or sufficiently below theirrespective thresholds. In certain embodiments, the determination of thenumber of MTSs 32 needed may also account for the forecasted load index.If the number of MTSs 32 needed is sufficiently greater than the currentnumber of active MTSs 32, then the assignment management module 42 maydetermine that a new station can be added, or activated, to the CMU 30(such as by adding an additional CMU technician 36). In this case, theassignment management module provides recommended patient reassignmentsto the newly activated MTS, thereby rebalancing the loads of the MTSs inthe CMU. Conversely, if the current number of patients and alarms issuch that the MTSs 32 are operating well below their respectivethresholds, then then the assignment management module 42 may determinethat one of the MTSs 32 can be removed from operation of the CMU 30(such as by relieving a CMU technician 36). For example, a determinationto add or remove an MTS 32 may be based on a threshold determinationbased on the load indexes 72 across all MTSs 32. In this case, theremaining patients on the MTS to be deactivated would be reassigned toother MTSs based on recommendations from the assignment managementmodule.

This written description uses examples to disclose the invention,including the best mode, and also to enable any person skilled in theart to make and use the invention. The patentable scope of the inventionis defined by the claims and may include other examples that occur tothose skilled in the art. Such other examples are intended to be withinthe scope of the claims if they have structural elements that do notdiffer from the literal language of the claims, or if they includeequivalent structural elements with insubstantial differences from theliteral languages of the claims.

I claim:
 1. A method of centralized patient monitoring management at acentralized monitoring unit (CMU), the method comprising: receivingpatient monitoring data from multiple patient monitoring devices, eachpatient monitoring device providing patient monitoring data for one ofmultiple patients; assigning each of the multiple patients to one of atleast two monitoring technician stations, each monitoring technicianstation having at least one display such that the monitoring technicianstation receives and displays on the at least one display patientmonitoring data for each patient in a group of patients assigned theretoand presents alarms for each patient in the group of patients to a CMUtechnician; calculating a load index for each monitoring technicianstation based on the alarms for each patient in the group of patientsassigned to the monitoring technician station, wherein the load indexfor each monitoring technician station is calculated based on at leastone of a number of active alarms at the monitoring technician station,an alarm type of each active alarm at the monitoring technician station,a burden value for the alarm type, a severity of each active alarm atthe monitoring technician station, a duration of continuous alarming atthe monitoring technician station, an actual response time by the CMUtechnician to one or more of the active alarms at the monitoringtechnician station, and a skill level of the CMU technician; removing atleast one patient from the group of patients assigned to a firstmonitoring technician station of the at least two monitoring technicianstations when the load index for the first monitoring technician stationexceeds a load threshold for the first monitoring technician station;and reassigning each of the at least one patient removed from the firstmonitoring technician station to a different one of the at least twomonitoring technician stations so as to distribute an overall alarm loadfor the CMU across all of the at least two monitoring technicianstations.
 2. The method of claim 1, further comprising identifying oneor more low-load monitoring technician stations; reassigning each of theat least one patient removed from the first monitoring technicianstation to one of the one or more low-load monitoring technicianstations.
 3. The method of claim 2, further comprising determining arespective load threshold for each of the at least two monitoringtechnician stations.
 4. The method of claim 3, further comprisingcomparing the load index for each monitoring technician station to theload threshold for the respective monitoring technician station toidentify the low-load monitoring technician station.
 5. The method ofclaim 3, further comprising determining the load threshold for each ofthe at least two monitoring technician stations based on at least one ofan overall alarm load for the CMU and a skill level of the CMUtechnician associated with the respective monitoring technician station.6. The method of claim 1, further comprising: calculating an alarmprobability within a future time period for each monitoring deviceassociated with a patient in the group of patients assigned to the firstmonitoring technician station; and identifying the at least one patientremoved from the first monitoring technician station as one or morepatients that are not currently alarming and are associated with ahighest alarm probability.
 7. The method of claim 1, further comprising:identifying one or more critical alarms for patients assigned to thefirst monitoring technician station; and removing the at least onepatient based on the identified critical alarms.
 8. The method of claim1, further comprising: identifying one or more unattended alarms forpatients assigned to the first monitoring technician station; andremoving the at least one patient based on the identified unattendedalarms.
 9. The method of claim 1, wherein the load index for eachmonitoring technician station is calculated based on at least two of anumber of active alarms at the monitoring technician station, an alarmtype of each active alarm at the monitoring technician station, a burdenvalue for the alarm type, a severity of each active alarm at themonitoring technician station, a duration of continuous alarming at themonitoring technician station, an actual response time by the CMUtechnician to one or more of the active alarms at the monitoringtechnician station, and a skill level of the CMU technician.
 10. Themethod of claim 1, wherein the reassigning each of the at least onepatient removed from the first monitoring technician station to adifferent one of the at least two monitoring technician stationsincludes moving a responding clinician assignment such that theresponding clinician assignment for the removed patient is maintained.11. The method of claim 1, further comprising automatically assigning anew patient to one of the at least two monitoring technician stationsbased on the load indexes.
 12. The method of claim 1, further comprisingdetermining a number of monitoring technician stations needed based onthe load indexes for the at least two monitoring technician stations;and adding or removing a monitoring technician station based on thenumber of monitoring technician stations needed.
 13. The method of claim1, further comprising operating the different one of the at least twomonitoring technician stations to receive and display the patientmonitoring data for and present the alarms for the at least one patientremoved from the first monitoring technician station.
 14. A centralizedmonitoring unit (CMU) receiving patient monitoring data from multiplepatient monitoring devices, each patient monitoring device providingpatient monitoring data for a respective one of multiple patients, theCMU comprising: at least two monitoring technician stations, eachmonitoring technician station having at least one display and configuredto: receive and display on the at least one display patient monitoringdata for each patient in a group of patients assigned thereto; presentalarms for each patient in the group of patients to a CMU technician;wherein each of the multiple patients for which patient monitoring datais received at the CMU is assigned to one of the at least two monitoringtechnician stations; an assignment management module executable by aprocessing system to: calculate a load index for each monitoringtechnician station wherein the load index for each monitoring technicianstation is calculated based on at least one of a number of active alarmsat the monitoring technician station, an alarm type of each active alarmat the monitoring technician station, a burden value for the alarm type,a severity of each active alarm at the monitoring technician station, aduration of continuous alarming at the monitoring technician station, anactual response time by the CMU technician to one or more of the activealarms at the monitoring technician station, and a skill level of theCMU technician; remove at least one patient of the multiple patientsfrom assignment to a first monitoring technician station of the at leasttwo monitoring technician stations based when the load index for thefirst monitoring technician station exceeds a load threshold for thefirst monitoring technician station; and reassign each of the at leastone patient removed from the first monitoring technician station to adifferent one of the at least two monitoring technician stations. 15.The CMU of claim 14, wherein each of the at least patient removed fromthe first monitoring technician station is assigned to the differentmonitoring technician station based on the load index for the differentmonitoring technician station so as to distribute an overall alarm loadfor the CMU across all of the at least two monitoring technicianstations.
 16. The CMU of claim 14, wherein the assignment managementmodule is further executable to determine that the load index for thefirst monitoring technician station is greater than load indexes forother ones of the at least two monitoring technician stations prior toremoving the at least one patient.
 17. The CMU of claim 14, wherein theload threshold for each of the at least two monitoring technicianstations is determined based on a skill level of the CMU technician atthe respective monitoring technician station.
 18. The CMU of claim 14,wherein the load threshold for each of the at least two monitoringtechnician stations is determined based on an overall alarm load for theCMU.
 19. The CMU of claim 14, wherein the assignment management moduleis further executable to: calculate an alarm probability within a futuretime period for each patient monitoring device associated with a patientin the group of patients assigned to the first monitoring technicianstation; identify one or more patients that are not currently alarmingand are associated with a highest alarm probability as the at least onepatient removed from the first monitoring technician station.
 20. TheCMU of claim 14, wherein the assignment management module is furtherexecutable to: identify one or more critical alarms for patientsassigned to the first monitoring technician station; and remove the atleast one patient based on the identified critical alarms.
 21. The CMUof claim 14, wherein the assignment management module is furtherexecutable to: identify one or more unattended alarms for patientsassigned to the first monitoring technician station; and remove the atleast one patient based on the identified unattended alarms.
 22. The CMUof claim 14, wherein the load index for each monitoring technicianstation is calculated based on at least two of a number of active alarmsat the monitoring technician station, an alarm type of each active alarmat the monitoring technician station, a burden value for the alarm type,a severity of each active alarm at the monitoring technician station, aduration of continuous alarming at the monitoring technician station, anactual response time by the CMU technician to one or more of the activealarms at the monitoring technician station, and a skill level of theCMU technician.
 23. The CMU of claim 14, wherein each of the at leastone patient removed from the first monitoring technician station isreassigned to the different one of the at least two monitoringtechnician stations such that the different one of the at least twomonitoring technician stations receives and displays on the at least onedisplay the patient monitoring data for and presents the alarms for theat least one patient removed from the first monitoring technicianstation.